同时根治性膀胱切除术和肾输尿管切除术的适应症和结果:系统回顾和比较分析。

IF 2.6 4区 医学 Q2 UROLOGY & NEPHROLOGY
Marwan Zein, Ali A Nasrallah, Nassib F Abou Heidar, Jad Najdi, Layal Hneiny, Albert El Hajj
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引用次数: 1

摘要

导读:尿路上皮癌可起源于膀胱或上尿路。在某些情况下,膀胱癌(UBC)和上尿路上皮癌(UTUC)可以同时诊断,需要联合根治性膀胱切除术(RC)和根治性肾输尿管切除术(RNU)。我们对联合手术的疗效和适应症进行了系统回顾,并对联合手术和单独膀胱切除术进行了比较分析。方法:对三个数据库(Embase、PubMed和Cochrane)进行系统评价,只选择包含术中和围术期数据的研究。为了进行比较分析,使用NSQIP数据库,使用RC和RNU的CPT编码识别两个队列,一个是RC和RNU,一个是RC单独。对所有术前变量进行描述性分析,并进行倾向评分匹配(PSM)。然后比较两个匹配队列的术后事件。结果:系统评价纳入28篇相关文章,共计947例接受联合手术的患者。最常见的适应症是同步多灶性疾病,最常见的方法是开放手术,最常见的转移技术是使用回肠导管。近28%的患者需要输血,平均住院时间为13天。术后最常见的并发症是长时间麻痹性肠梗阻。为了进行比较分析,纳入了11,759例患者,其中97.5%的患者只接受了RC, 2.5%的患者接受了联合手术。在PSM后,接受联合手术的队列显示肾损伤的风险增加,再入院率增加,再手术率增加。然而,接受RC的队列仅显示深静脉血栓形成(DVT)、败血症或感染性休克的风险增加。结论:联合RC和RNU是并发UCB和UTUC的治疗选择,应谨慎使用,因为它与高发病率和死亡率相关。患者选择,讨论手术的风险和益处,以及解释可用的治疗方案仍然是管理患有这种复杂疾病的患者最重要的支柱。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis.

Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis.

Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis.

Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis.

Introduction: Urothelial carcinoma can arise from the urinary bladder or from the upper urinary tract. In some instances, urinary bladder cancer (UBC) and upper tract urothelial carcinoma (UTUC) can be concurrently diagnosed, necessitating a combined radical cystectomy (RC) with radical nephroureterectomy (RNU). A systematic review was done on the combined procedure exploring outcomes and indications, in addition to a comparative analysis between the combined procedure and cystectomy alone.

Methods: For the systematic review, three databases (Embase, PubMed, and Cochrane) were queried, selecting only studies that included intraoperative and perioperative data. For the comparative analysis, using the NSQIP database, CPT codes for RC and RNU were used to identify two cohorts, one with RC and RNU and one with RC alone. A descriptive analysis was performed on all preoperative variables, and propensity score matching (PSM) was performed. Postoperative events were then compared between the two matched cohorts.

Results: For the systematic review, 28 relevant articles were included amounting to 947 patients who underwent the combined procedure. The most common indication was synchronous multifocal disease, the most common approach was open surgery, and the most common diversion technique was using an ileal conduit. Almost 28% of patients required blood transfusion and remained in the hospital for an average of 13 days. The most common postoperative complication was prolonged paralytic ileus. For the comparative analysis, 11,759 patients were included of which 97.5% underwent RC only and 2.5% underwent the combined procedure. After PSM, the cohort that had undergone the combined procedure showed an increased risk of renal injury, increased readmission rates, and increased reoperation rates. Whereas the cohort that had undergone RC only showed an increased risk of deep venous thrombosis (DVT), sepsis, or septic shock.

Conclusion: A combined RC and RNU is a treatment option for concurrent UCB and UTUC that should be cautiously utilized as it is associated with high morbidity and mortality. Patient selection, discussion of the risks and benefits of the procedure, and explanation of the available treatment options remain the most important pillars in managing patients with this complex disease.

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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
39
审稿时长
10 weeks
期刊介绍: Therapeutic Advances in Urology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of urology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in urology, providing a forum in print and online for publishing the highest quality articles in this area. The editors welcome articles of current interest across all areas of urology, including treatment of urological disorders, with a focus on emerging pharmacological therapies.
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